Direct Ophthalmoscopy Teaching of Medical Students Based on a Standardised Simulator-based Procedure Versus the Classic Ophthalmoscope

Abstract

Purpose Direct ophthalmoscopy (DO) teaching in medical curricula may be performed as classical or simulator-based DO. This interventional study evaluated both options.

Methods 110 medical students received a multiple-choice questionnaire (four theory questions, six fundus photographs) prior to simulator-based (EyeSi Direct, Haag-Streit Simulation, Germany) and classical DO training (Heine BETA200, Heine Optotechnik GmbH, Germany). Training was performed in groups of eight students. Thereafter, they underwent an objective standardised clinical examination containing questions about (1) pupil dilation, (2) mydriasis contraindication, (3) ophthalmoscope adjustment and a practical test checking whether (1) optic nerve head, (2) macula, (3 – 6) upper/lower vessel arcade nasally versus temporally were identified correctly. Subsequently, classic DO was performed mutually and they reported the recognised funduscopic structures. Finally, the questionnaire was repeated one week later in combination with an evaluation of simulator-based versus classic DO.

Results Students improved from an average of 4.0 ± 1.5/10 before to 8.8 ± 1.5/10 correctly answered questions after training (p < 0.0001, Wilcoxon matched-pairs test). 87|34|61 students named pupil dilating time|mydriasis contraindication and adjusted the ophthalmoscope correctly. They successfully identified the optic nerve head (n[simulator]|n[classic] DO: 110|68, p < 0.0001, Fisherʼs exact test), the macula (93|22, p < 0.0001), the upper (98|75, p = 0.0002) and lower temporal vessel arcade (101|91, p = 0.0672), the upper (84|56, p = 0.0001) and lower nasal vessel arcade (87|48, p < 0.0001). They wished for more simulator-based training, indicated more interest in ophthalmology after training and indicated an improvement in their ophthalmoscopy skills.

Conclusion A standardised simulator-based approach improves medical studentsʼ skills in ophthalmoscopy and arouses professional interest in ophthalmology.

Zusammenfassung

Hintergrund Der Unterricht der direkten Funduskopie in medizinischen Curricula kann klassisch oder simulatorgestützt durchgeführt werden. Diese Interventionsstudie evaluiert beide Optionen.

Methoden 110 Medizinstudierende beantworteten einen Multiple-Choice-Fragebogen (4 Theoriefragen, 6 Fundusfotos) vor einem simulatorbasierten (EyeSi Direct, Haag-Streit Simulation, Deutschland) und klassischen direkten Funduskopie-Praktikum (Heine BETA200, Heine Optotechnik GmbH, Deutschland). Das Praktikum erfolgte in Gruppen von 8 Studierenden. Anschließend unterzogen sie sich einer objektiven, standardisierten klinischen Untersuchung mit Fragen zur (1) Dauer der Pupillenerweiterung, (2) Kontraindikation für Mydriasis, (3) Einstellung des Ophthalmoskops und einem praktischen Test am Simulator, ob (1) Sehnervenkopf, (2) Makula, (3 – 6) obere/untere Gefäßbogen nasal vs. temporal korrekt identifiziert wurden. Die klassische direkte Funduskopie wurde gegenseitig durchgeführt und die identifizierten Fundus-Strukturen erhoben. Schließlich wurde der Multiple-Choice-Fragebogen 1 Woche später zusammen mit einer Evaluation des Praktikums wiederholt.

Ergebnisse Die Studierenden verbesserten sich von durchschnittlich 4,0 ± 1,5/10 vor auf 8,8 ± 1,5/10 richtig beantwortete Fragen nach dem Praktikum (p < 0,0001, gepaarter Wilcoxon-Test). 87|34|61 Studierende benannten die Dauer bis zur Mydriasis, die Kontraindikation für Mydriasis und stellten das Ophthalmoskop korrekt ein. Die erfolgreiche Identifikation von Fundus-Strukturen erfolgte beim Sehnervenkopf (n [Simulator])|n [klassisch]: 110|68, p < 0,0001, exakter Fisher-Test), der Makula (93|22, p < 0,0001), dem oberen (98|75, p = 0,0002) und unteren temporalen Gefäßbogen (101|91, p = 0,0672) sowie dem oberen (84|56, p = 0,0001) und unteren nasalen Gefäßbogen (87|48, p < 0,0001). Die Studierenden wünschten sich mehr simulatorgestützte Praktikumszeit, zeigten nach dem Praktikum ein größeres Interesse am Fach Augenheilkunde und gaben eine Verbesserung ihrer funduskopischen Fähigkeiten an.

Schlussfolgerung Ein standardisierter simulatorgestützter Ansatz verbessert die funduskopischen Fähigkeiten der Medizinstudierenden und weckt das berufliche Interesse am Fach Augenheilkunde.

Conclusion Box

Already known:

• Medical students lack confidence and competence in performing direct ophthalmoscopy.

• Simulation may be helpful in direct ophthalmoscopy teaching and training.

• The current study assessed the studentsʼ experience and learning success after training direct ophthalmoscopy with both a simulator and a classic ophthalmoscope.

Newly described:

• Simulator-based direct ophthalmoscopy training cannot (yet) replace classic direct ophthalmoscopy.

• Medical students preferred a combination of simulation and classic direct ophthalmoscopy over either of the two methods alone.

• Direct ophthalmoscopy training as described in the current study increases interest and enthusiasm for the subspecialty of ophthalmology.

Keywords

simulation - ophthalmoscopy - teaching

Schlüsselwörter

Simulation - Funduskopie - Lehre

Publication History

Received: 27 January 2025

Accepted: 13 November 2025

Article published online:
26 January 2026

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